Divisions of Hematology and Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Cancer. 2012 Mar 15;118(6):1585-92. doi: 10.1002/cncr.26422. Epub 2011 Aug 25.
Early versus delayed autologous stem cell transplantation (SCT) results in comparable overall survival in patients with multiple myeloma (MM) who receive alkylator-based therapies. It is not clear whether this paradigm holds true in the context of new therapies, such as immunomodulatory drugs (IMiDs).
The authors studied 290 patients with untreated MM who received IMiD-based initial therapy, including 123 patients who received thalidomide-dexamethasone (TD) and 167 patients who received lenalidomide-dexamethasone (LD) induction before SCT. Patients who underwent a stem cell harvest attempt were considered transplantation-eligible and were included. SCT within 12 months of diagnosis and within 2 months of harvest were considered early SCT (n = 173; 60%). SCT >12 months after diagnosis was considered delayed SCT (n = 112; 40%).
In the delayed SCT group, 42 patients had undergone SCT at the time of the current report, and the median estimated time to SCT was 5.3 months and 44.5 months in the early SCT and delayed SCT groups, respectively. The 4-year overall survival rate from diagnosis was 73% in both groups (P = .3) and was comparable in those who received TD (68% vs 64%, respectively) and those who received LD (82% vs 86%, respectively) as initial therapy. The time to progression after SCT was similar between the early and delayed SCT groups (20 months vs 16 months; P value nonsignificant).
The current results indicated that, in transplantation-eligible patients who receive IMiDs as initial therapy followed by early stem cell mobilization, delayed SCT results in similar overall survival compared with early SCT. It is noteworthy that an excellent 4-year survival rate of >80% was observed among transplantation-eligible patients who received initial therapy with LD regardless of the timing of transplantation.
对于接受烷化剂为基础的治疗方案的多发性骨髓瘤（MM）患者，早期与延迟自体干细胞移植（SCT）的结果在总体生存率方面相当。在新的治疗方法（如免疫调节药物（IMiD））的背景下，这种模式是否成立尚不清楚。
作者研究了 290 例接受 IMiD 为基础的初始治疗的未经治疗的 MM 患者，其中 123 例患者接受沙利度胺-地塞米松（TD）治疗，167 例患者接受来那度胺-地塞米松（LD）诱导后进行 SCT。进行干细胞采集尝试的患者被认为有移植资格并被纳入研究。诊断后 12 个月内和采集后 2 个月内进行 SCT 被认为是早期 SCT（n=173；60%）。诊断后 12 个月以上进行 SCT 被认为是延迟 SCT（n=112；40%）。
在延迟 SCT 组中，在本报告时，42 例患者已经进行了 SCT，早期 SCT 和延迟 SCT 组的中位估计 SCT 时间分别为 5.3 个月和 44.5 个月。两组从诊断到 4 年的总生存率分别为 73%（P=0.3），接受 TD 治疗（68%与 64%）和接受 LD 治疗（82%与 86%）的患者之间的生存率相当。SCT 后进展的时间在早期 SCT 和延迟 SCT 组之间相似（20 个月比 16 个月；P 值无统计学意义）。
目前的结果表明，在接受 IMiD 作为初始治疗，随后进行早期干细胞动员，有移植资格的患者中，延迟 SCT 的结果与早期 SCT 相比，总体生存率相似。值得注意的是，无论移植时机如何，接受 LD 作为初始治疗的有移植资格的患者均观察到 4 年生存率超过 80%的优异结果。
